Adolecscent

 An adolescent, often referred to as a teenager, is an individual in the  transitional stage of development between childhood and adulthood,  typically spanning the ages of thirteen to nineteen years old. This  developmental period is characterized by significant physical,  cognitive, emotional, and social changes as adolescents navigate the  transition from dependency on caregivers to greater independence and  autonomy. Adolescents experience rapid growth and maturation, including  pubertal changes such as the development of secondary sexual  characteristics, hormonal fluctuations, and changes in body composition.  Psychologically, adolescents undergo cognitive development, abstract  thinking, identity formation, and exploration of personal values,  beliefs, and goals. Socially, they form relationships with peers,  establish social networks, and develop a sense of belonging and identity  within peer groups. Adolescents also face increasing pressure to  conform to societal norms, academic expectations, and peer influences  while navigating challenges such as peer pressure, risk-taking  behaviors, and identity exploration. Overall, adolescence is a dynamic  and formative stage of development that shapes individuals' future  health, relationships, and identity. 

• Mental Health Disorders: Conditions such as depression, anxiety disorders, eating disorders, substance use disorders, and self-harming behaviors, which can significantly impact adolescents' emotional well-being, behavior, academic performance, and social relationships.
• Sexually Transmitted Infections (STIs): Infections transmitted through sexual contact, including human papillomavirus (HPV), chlamydia, gonorrhea, herpes, and HIV/AIDS, which can have serious health consequences if left untreated and may result in stigma, discrimination, and social challenges for affected adolescents.
• Eating Disorders: Conditions such as anorexia nervosa, bulimia nervosa, and binge-eating disorder, characterized by abnormal eating behaviors, distorted body image, and excessive concern about weight and body shape, which can lead to physical health complications, emotional distress, and impaired functioning.
• Substance Abuse and Addiction: Misuse or abuse of alcohol, tobacco, prescription medications, or illicit drugs, which can have detrimental effects on adolescents' physical health, mental health, academic performance, and social relationships, increasing the risk of accidents, injuries, and legal problems.
• Reproductive Health Issues: Including unintended pregnancies, unsafe abortions, menstrual disorders, polycystic ovary syndrome (PCOS), and pelvic inflammatory disease (PID), which can impact adolescents' physical health, educational attainment, and social well-being.

 Hyperinsulinemia, insulin resistance, and metabolic syndrome are not  typically implicated in the major disorders of adolescents such as  mental health disorders, sexually transmitted infections (STIs), eating  disorders, substance abuse, and reproductive health issues. These

etabolic abnormalities are more commonly associated with conditions  that develop later in life, particularly in adulthood, and are  influenced by factors such as genetics, lifestyle, and environmental  exposures. However, promoting healthy metabolic habits from an early age  is essential for reducing the risk of metabolic disorders in adulthood.  This includes encouraging a balanced diet, regular physical activity,  adequate sleep, and limiting exposure to environmental toxins.  Additionally, addressing mental health concerns, promoting healthy  relationships, providing comprehensive sexual education, and offering  access to reproductive health services are crucial for supporting the  overall health and well-being of adolescents. Regular medical check-ups  and screening for risk factors are important for identifying and  addressing any potential health concerns in adolescents. 

  Obesity rates among adolescents have been steadily increasing globally,  posing a significant public health challenge. The prevalence of obesity  in adolescence varies by region and country, with higher rates observed  in developed countries and certain ethnic groups. Factors contributing  to the rising prevalence of obesity in adolescence include changes in  dietary habits, decreased physical activity, and environmental factors.  Adolescent obesity increases the risk of various health complications,  including metabolic disorders, cardiovascular diseases, and  psychological issues. Preventive measures, such as promoting healthy  lifestyles, encouraging physical activity, and addressing social  determinants of health, are essential for mitigating the risk of obesity  and promoting optimal health outcomes during adolescence. 

  Obesity in adolescence can have significant health implications,  affecting both physical and psychological well-being. Adolescents with  obesity are at increased risk of developing metabolic disorders, such as  insulin resistance and dyslipidemia, which can lead to type 2 diabetes  and cardiovascular disease later in life. Additionally, obesity in  adolescence may lead to psychological issues, including poor  self-esteem, depression, and social stigma. Long-term consequences of  adolescent obesity include an increased risk of obesity-related chronic  diseases and premature mortality in adulthood. Addressing obesity in  adolescence through early intervention, lifestyle modifications, and  comprehensive care is crucial for reducing the risk of these health  complications and promoting long-term health and well-being. 

" Did you know the American Academy of Pediatrics guidelines for obesity and metabolic disease recommend that a 13 year old child get bariatric surgery or an injection hormone to lose weight and reverse disease, but that a Low Carb Diet requires intense medical supervision?   Given these biased and over-medicalized recommendations, a group of doctors including myself @doctorTro,  @LauraBuchananMD,@MattCalkinsMD,@drericwestman Dr. Mark Cuccuzella, and 

@DikemanDave

wrote a response to the editor. They actually refused to publish that response, so we submitted it to  @TheSMHP

 Journal of Metabolic Health    What did our review find? They confused 4:1 ketogenic diets with well formulated low-carb diets They omitted data demonstrating the benefits of low-carb diets. They had ZERO authors who actually have clinical experience with low-carb diets. You can review our response paper: We argue that therapeutic carbohydrate reduction (TCR) for treating metabolic diseases in children should not be confused with 4:1 ketogenic diets used for epilepsy. We criticize the bias in current pediatric dietary guidelines which conflate the two, noting that TCR is safer and more nutrient-dense, making it suitable for managing conditions like diabetes and obesity in children without the risks typically associated with strict ketogenic diets. We also advocate for more flexible and inclusive dietary guidelines that recognize the benefits and safety of TCR.  

" Recent reviews of using therapeutic carbohydrate reduction to treat  metabolic disease in paediatric patients have consistently made errors  in the form of bias against recommending this nutrient-dense eating  pattern despite strong evidence for its use in adults and emerging  evidence in paediatric patients. The purpose of this perspective is to  review these errors, which include conflating 4:1 ketogenic diets with  well-formulated ketogenic diets and the needless medicalisation of using  therapeutic carbohydrate reduction in paediatric populations. "

 The prevalence of type 2 diabetes in adolescence has been increasing in  recent years, paralleling the rise in obesity rates and changes in  lifestyle factors. While type 2 diabetes is less common in adolescence  compared to adulthood, the incidence of early-onset diabetes is rising,  particularly among certain ethnic groups and populations with a high  prevalence of obesity. The rising prevalence of type 2 diabetes in  adolescence underscores the importance of early detection, preventive  measures, and lifestyle interventions to mitigate the risk of  complications and optimize long-term health outcomes. 

 Type 2 diabetes in adolescence can have serious health consequences,  affecting both physical and psychological well-being. Adolescents with  diabetes require ongoing medical management, including blood glucose  monitoring, insulin therapy, and dietary modifications, to maintain  optimal health and prevent complications. Uncontrolled diabetes in  adolescence can lead to short-term complications such as hypoglycemia,  hyperglycemia, and diabetic ketoacidosis, which require prompt medical  attention. Long-term implications of early-onset diabetes may include an  increased risk of obesity-related chronic diseases, cardiovascular  disease, and kidney disease in adulthood. Early diagnosis, comprehensive  care, and ongoing monitoring are essential for managing type 2 diabetes  in adolescence and promoting optimal health outcomes throughout life. 

    Obesity indices and lipid/lipoprotein fractions are significantly associated risk factors with IR andmight be used as significant indicators formetabolic complications among obeseadolescents
(PDF) Risk factors predicting insulin resistance in obese adolescents.  

Available from: https://www.researchgate.net/publication/370107229_Risk_factors_predicting_insulin_resistance_in_obese_adolescents#fullTextFileContent [accessed Mar 18 2024]. 

  Our study provides evidence that children with se veral components of MS mainly have a inflammatory  state and/or IR, appearing even before meeting the ful filled diagnostic criteria, with an adequate number of  studied subjects, conducted prospectively and simulta neously measuring physical and biochemical parame ters. Our population segment has a high percentage of  obesity. This does not invalidate our results, because  our study does not attempt to know MS prevalence,  but rather of the correlation of its components with  new markers of early endothelial damage.  Studies with a representative sample of the general  population may be able to reduce bias and determi ne the normal levels of these markers in pediatric age,  since they could be a useful tool for determining the  presence of endothelial inflammation in children and  in the future could be helpful to properly estimate car diometabolic risk in our children 

   Insulin resistance is highly prevalent in obese children and  adolescents. The onset of Impaired Glucose Tolerance, ( IGT () is associated with the development of  severe hyperinsulinemia as there are no predictive cutpoint values of  insulin resistance or insulin sensitivity indexes for IGT, and neither  fasting blood glucose nor insulin levels nor HOMA-IR or HOMA %B are  effective screening tools; an OGTT is required in all subjects at high  risk. Longitudinal studies are needed to identify the metabolic  precursors and the natural history of the development of type 2 diabetes  in these patients. 

  Oral glucose tolerance tests (OGTT) are used to measure how well the  body can process a larger amount of sugar. If the blood sugar measured  in the test is above a certain level, this could be a sign that sugar is  not being absorbed enough by the body’s cells. Diabetes or gestational  diabetes might be at the root of this problem.

In gestational  diabetes, blood sugar levels are often higher due to changes in the  metabolism during pregnancy – but they usually come back down again  after the child is born.

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There  are two types of glucose tolerance tests: a short version called the  glucose challenge test, and a full glucose tolerance test. The short  version is easier to do and serves as a preliminal test to determine  someone's risk of diabetes or gestational diabetes.

The  glucose challenge test is the short version of the glucose tolerance  test. The test can be done at any time of the day. It involves drinking a  glass of concentrated glucose solution (50 g of glucose dissolved in  250 to 300 ml of water). After one hour has passed, a blood sample is  taken to determine the blood sugar level.

For  this test, you should not eat anything before going to the doctor in  the morning. In other words, you should not have breakfast, and you  should eat your last meal the evening before. This also applies to all  drinks with the exception of water.

First of all, blood is taken  to determine your baseline blood sugar level. The blood is drawn from a  vein or your fingertip or earlobe. After that you drink a large glass of  concentrated sugar solution. In the glucose tolerance test, 75 g of  glucose are dissolved in 250 to 300 ml of water. The amount given to  children is based on their body weight. If the test is being done to  confirm suspected diabetes, blood is drawn again after two hours and the  blood sugar level is measured. When testing for gestational diabetes,  blood is drawn twice – first after one hour and then again after another  two hours.

It is recommended that you do the test while lying  down or sitting, and do not eat, drink or smoke until the last blood  sample is taken. It is also important that you maintain a normal,  balanced diet in the days leading up to the test. Major changes in your  eating habits, like going on a diet, can influence the results of the  test and make them less reliable. Some medications can al

 "Obesity is a hazard mark that associated with insulin resistance (IR).  This study aimed to detect which risk factors might provide the greatest  predictive value for IR in obese adolescents aged thirteen to seventeen  years. One hundred obese adolescents with IR and matched age and sex  100 obese healthy controls without IR were included. Anthropometry,  serum lipids and metabolic biomarkers were measured. Homeostasis Model  Assessment of Insulin Resistance (HOMA-IR) was used to determine insulin  Resistance. Significant increase in serum lipids and metabolic  parameters in obese cases with IR compared to those without. Positive  correlations were observed between obesity measurements and metabolic  risk markers, including increase of waist to hip ratio (WHR), sum of  skin folds, blood pressure, insulin, HOMA-IR, TC, TG and LDL-C levels  and decrease of HDL-C in IR adolescents. WHR showed the highest  correlations with biochemical markers in IR cases. WHR was able to  predict IR with area under the curve = 0.82 and TG-to-HDL-C ratio with  area under the curve = 0.87. WHR and lipid/lipoprotein fractions are  significantly associated with IR in obese adolescents and might be used  for the prediction of IR and for cases at high risk for early  intervention. 

 "High levels of serum uric acid, UAR, UCR, and UHR were associated with obesity. Furthermore, we found that uric acid, UAR, and UHR were positively correlated with insulin resistance".

" The increase in serum uric acid showed a positive statistical  correlation with insulin resistance and it is associated with and  increased risk of insulin resistance in obese children and adolescents.   "